House Votes to Repeal Obamacare Provision

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Originally Posted by Lewkowski

Of course it is. Now how many regulations are on the healthcare system?

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Your healthcare system is inefficient because it's a system full of unnecessary diagnostic procedures, unnecessary/ineffective treatments and care, unnecessary administrative complexity from having to deal with too many insurance plans, and unnecessary serious emergencies that would have been avoided if your people had better coverage. These are not the only reasons but every single analysis I've seen over the past few years identify the above as the prime drivers of waste in your healthcare system. You can blame the government all you like but it's not usually the government that forces doctors to take money from patients for doing unnecessary things, and atm it's not the government who wants to keep denying basic primary care to the fraction of the population that cost you the most in emergency care.

You have your ideals where people are more productive at work when they're sick and broke, and that's all right. But the causes of your healthcare-system's lack of efficiency have been thoroughly investigated, and government regulations don't pop up as the main causes. Some might argue that they are the most important indirect causes, but the most important contribution of your government to your wasteful healthcare system seems to have been the willingness to pay for it.

It's much better to have the English system where getting expensive diagnostic treatment is virtually impossible and waiting lines of over a month for any non-life threatening treatment are the norm.

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Originally Posted by Loki

It's much better to have the English system where getting expensive diagnostic treatment is virtually impossible and waiting lines of over a month for any non-life threatening treatment are the norm.

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That's a slightly different issue from efficiency and effectivity. That being said, you're welcome to defend the first statement and relate that to the disparities in access to healthcare one sees in the US. You hadn't forgotten that part had you? :o

A system that can get timely access to proper tests for 85% is better than one that grants such access to 1%.

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Originally Posted by Loki

A system that can get timely access to proper tests for 85% is better than one that grants such access to 1%.

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And yet the problem in the US is the "timely access" to unnecessary tests and treatments; much of the remaining expenses arise due to disparities in "timely access" to basic care. So, look, you really don't have a leg to stand on, any more than you did when you were muttering about gamma knives. Now the NHS isn't exactly flawless, but it's doing a far better job with its money than you are. The US is wasting its money and it's bizarre to see you trying to justify that waste by insinuating that waste is value :bulb:

If by efficient, you mean regularly refusing to provide necessary tests, then sure, the NHS is more efficient than the American system.

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Originally Posted by Loki

If by efficient, you mean regularly refusing to provide necessary tests, then sure, the NHS is more efficient than the American system.

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By efficient I mean not wasting a third of its money on unnecessary tests and treatments and insurance administration, and even more on cleaning up the mess that arises from not giving people adequate access to basic healthcare. I'll say it again: you don't have a leg to stand on. And your insurance won't cover prosthetics.

You can rail against the imagined failings of the NHS all you like, but, at the end of the day, the inexcusable and preventable problems of your own system remain. It's so weird that you really seem to believe the US healthcare system is that much better than that of other western countries when in reality it's mostly just average despite the amount of money that goes into it :bulb: probably because of the money that goes into it.

I look forward to the day you guys learn about being cost-effective :o

I find it amusing that you consider overtreatment to be inexcusable but undertreatment to be a non-issue.

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Originally Posted by Loki

I find it amusing that you consider overtreatment to be inexcusable but undertreatment to be a non-issue.

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Not so funny if you look at the undertreatment in our system that ends in emergency room visits that cost you money even though you aren't the one making the visit. :confused: Preventative care could eliminate many of those unnecessary emergency room visits. I call that underteatment. What do you call it?

Unnecessary preventive treatment? How dare you even suggest that. Minx is now going to shout at you for wasting money. :(

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Originally Posted by Loki

I find it amusing that you consider overtreatment to be inexcusable but undertreatment to be a non-issue.

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I do consider undertreatment to be an important issue, if you'd read my posts you'd know that (since they're right here in this thread you can actually go read them now) :bulb: in fact it's an important issue in the US where undertreatment eg. leads to people costing much more money due to preventable emergencies. What, you imagined that undertreatment doesn't occur in the US because you have over-treatment? What you have is unnecessary treatment and unnecessary diagnostic procedures. That doesn't mean you only do too much of the good stuff where the bonus is just good; too often you do the wrong stuff at the wrong time. I find it incredible that you guys still have so many life-threatening emergencies and tragic complications due to eg. people desperately trying to stretch out their asthma medication or their insulin.

I have no doubt these problems also exist in the rest of the western world (although I'm willing to bet that, overall, most of the rest of the western world compares favorably to the US), but the difference is you guys pay far more for this privilege than anyone else does. You seem to have lost track of the original topic for this sub-discussion, which is Lewk's assertion that your healthcare-system is inefficient and wasteful due to government regulation. My counter-claim is that the primary sources of waste in the US healthcare system aren't directly government-related, that the government's greatest fault is not regulation so much as its (forced!) willingness and "ability" to pay through the nose with tax dollars and borrowed money for the unsound medical practices fostered in your country, and its historical unwillingness to address the causes behind those unsound practices.

Do you even understand why it's important (for patients and for society and sometimes even for doctors) to ensure that doctors use appropriate diagnostic measures and appropriate treatment?

Jesus. Suck it up and learn from like Kaiser or something.

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Originally Posted by Loki

Unnecessary preventive treatment? How dare you even suggest that. Minx is now going to shout at you for wasting money. :(

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Look if I need to be more clear in my posts I'll try to be, but you'll still actually have to try to read what I've actually written in them.

For your benefit, I have emphasised the relevant parts of my posts that address the issue of "undertreatment".

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Originally Posted by Aimless

What you have is unnecessary treatment and unnecessary diagnostic procedures. That doesn't mean you only do too much of the good stuff where the bonus is just good; too often you do the wrong stuff at the wrong time. I find it incredible that you guys still have so many life-threatening emergencies and tragic complications due to eg. people desperately trying to stretch out their asthma medication or their insulin.

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Yep, because millions don't have primary care access, and wind up using the emergency room for basic care. Sometimes that's just to get a Rx refill for asthma meds or insulin, but often it's when they're in the midst of a full-blown asthma emergency, or have a pre-gangrenous toe. :(

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.... Lewk's assertion that your healthcare-system is inefficient and wasteful due to government regulation. My counter-claim is that the primary sources of waste in the US healthcare system aren't directly government-related, that the government's greatest fault is not regulation so much as its (forced!) willingness and "ability" to pay through the nose with tax dollars and borrowed money for the unsound medical practices fostered in your country, and its historical unwillingness to address the causes behind those unsound practices....

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Agreed. But the common US refrain in many political camps is that anything the government touches turns sour and, therefore, gov't shouldn't touch anything. That line of thinking becomes "privatize everything", with an almost romantic revision of history when medical care was totally privatized....but not nearly as complicated or expensive as it is today.

It's easy to theorize that poor people could get care through private "charitable" philanthropies or religious groups, and that's true to a degree. But it would be a low level of care that wouldn't necessarily include chronic dialysis, open heart surgery, joint replacements, premature/neonatal ICU.....or chemotherapy for millions of cancer patients.

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Originally Posted by Loki

I find it amusing that you consider overtreatment to be inexcusable but undertreatment to be a non-issue.

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I find it rather amusing you always only compare to the UK, as if that is the only alternative to what you have. I'd say Obamacare would be closer to, IIRC, Dutch or Swiss systems (could be wrong here). And not all countries have waiting lists like the UK. Show that the US is superior to at least multiple western countries, and you'd have an argument. Compare only to the NHS? Not really.

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Originally Posted by Loki

A system that can get timely access to proper tests for 85% is better than one that grants such access to 1%.

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And how does the US system rate that way? Very poorly. The only way millions of people can get timely access to 'proper tests' is by over-charging and over-testing those with private insurance, and shifting the costs around. When public funds don't cover costs, because there are limits or caps on reimbursement, providers will simply raise the charges for private payers.

That might be a way to recoup their costs of doing business, but it doesn't do a damn thing to keep prices from escalating...

or make for better diagnostics and treatment for 85% of a population. Try it with Diabetes type II, and see why it's being called an 'epidemic'.

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Originally Posted by Flixy

I find it rather amusing you always only compare to the UK, as if that is the only alternative to what you have. I'd say Obamacare would be closer to, IIRC, Dutch or Swiss systems (could be wrong here). And not all countries have waiting lists like the UK. Show that the US is superior to at least multiple western countries, and you'd have an argument. Compare only to the NHS? Not really.

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He could compare it to the Canadian system, which makes the US look really good, but then everyone would bitch about it not being a fair comparison because it's more like the British system with its public and private duality.

The US doesn't compare very well to any of the higher-rated healthcare systems, and they have public/private duality, too.

In fact, the US doesn't compare well within our own country, between places with good working systems (Mayo model) and those that don't. States and intrastate regions have massive differences in access, quality, results and costs. Even though public programs like Medicaid/Medicare have some national standards, what patients get are literally all over the map. Same is true for private insurance with strict regional preferred-provider and out-of-network restrictions. :rolleyes:

You're not going to convince Cain that Canada is better at anything than anyone, even though they have a warship and everything.

:haha: I was commenting to Flixy, Loki, and you.

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Originally Posted by GGT

The US doesn't compare very well to any of the higher-rated healthcare systems, and they have public/private duality, too.

In fact, the US doesn't compare well within our own country, between places with good working systems (Mayo model) and those that don't. States and intrastate regions have massive differences in access, quality, results and costs. Even though public programs like Medicaid/Medicare have some national standards, what patients get are literally all over the map. Same is true for private insurance with strict regional preferred-provider and out-of-network restrictions. :rolleyes:

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That only because they use some pretty damned poor metrics. Life expectancy only works as a standard if the subjects have similar diets, genetics and exercise level. Its no secret that a lot of Americans eat far more crap then the Euro folks do. America is a fat nation and only someone blind wouldn't realize that has a huge health consequence.

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Originally Posted by Lewkowski

That only because they use some pretty damned poor metrics. Life expectancy only works as a standard if the subjects have similar diets, genetics and exercise level. Its no secret that a lot of Americans eat far more crap then the Euro folks do. America is a fat nation and only someone blind wouldn't realize that has a huge health consequence.

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You do know that life expectancy is just one variable used in rating healthcare systems, right? :donkey:

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Originally Posted by GGT

You do know that life expectancy is just one variable used in rating healthcare systems, right? :donkey:

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Sure but its the main one cited in these debates.

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Originally Posted by Lewkowski

Sure but its the main one cited in these debates.

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No, it's not. 'These debates' have always included plenty of other variables. Like birth weights and infant mortality, access to preventative care (including vaccinations and cancer screenings), numbers of physicians in specialties, affordability at entry-level participation, numbers and prices of procedures, costs at end-of-life, and costs per patient as well as percentage of GDP. The US isn't at the top in anything except the amount of money we spend.

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Originally Posted by GGT

The US isn't at the top in anything except the amount of money we spend.

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I love how this comes up as an argument for untold trillions in more government spending.

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Originally Posted by Lewkowski

Sure but its the main one cited in these debates.

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No it's not, jesus, have you not followed a single one of the discussions we've had on this topic over the past decade? :bulb:

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Originally Posted by Lewkowski

Of course it is. Now how many regulations are on the healthcare system?

The market is distorted as well by government programs, special tax breaks (which is why we have an employer driven health insurance system btw) and other acts of big government.

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Yeah but it is also inefficient compared to any healthcare system with the same regulations offering universial healthcare.

"Free market tends towards cost efficency" well in general I agree, but free market tend also torwards a maximum of volume. And that's actually exactly what we don't want in healthcare, we don't want to have a maximum of threadments & medication but a maximum in health.

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Originally Posted by earthJoker

And that's actually exactly what we don't want in healthcare, we don't want to have a maximum of threadments & medication but a maximum in health.

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Why's that?

What's wrong with applying the same concepts to healthcare that we apply to every other market?

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Originally Posted by CitizenCain

Why's that?

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A maximimum of threadments does not at all lead to the best result, same for medication.

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What's wrong with applying the same concepts to healthcare that we apply to every other market?

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Because that would mean that patients have the same knowledge about medicine as doctors. Not possible. And the Loki way out (asking another doctor to know what you want or need) will result in a huge overhead.

There is an inherent problem with healthcare, that is to find out what is actually necessary. There is always that other CT, or MRI that you could do, but is it necessary?

Huh...and here I thought getting a second opinion was a good thing.

European healthcare: the doctors always know best. Don't question them or they'll mock you and/or throw you out of the office.

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Originally Posted by Veldan Rath

Huh...and here I thought getting a second opinion was a good thing.

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Getting a second opinion and doing a second test aren't the same. We often request second opinions on eg. CT:s or on treatments (and patients will sometimes--but not very often--request a second opinion) but we generally prefer to not make patients undergo extra unnecessary CT:s.

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Originally Posted by Loki

European healthcare: the doctors always know best. Don't question them or they'll mock you and/or throw you out of the office.

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Since I've never once seen a doctor mock a patient or throw one out for questioning his judgement I don't really know what to say to that. The caricature of the greedy American doctor encouraging (wheedling, threatening) patients to undergo unnecessarily expensive diagnostic procedures and treatments comes to mind.

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Originally Posted by Veldan Rath

Huh...and here I thought getting a second opinion was a good thing.

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Two doctors can look at the same CT/MRI. Actually I once could join such a double session on a MRI.

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Originally Posted by Loki

European healthcare: the doctors always know best. Don't question them or they'll mock you and/or throw you out of the office.

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Have you ever tried to make a diagnosis opon looking at a MRI? Have you ever watched a doctor making diagnostics? I assisted many doctors in my service and I can assure you, it isn't enough to have watched Grey's Anatomy to be able to make your own judgement.

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Originally Posted by Aimless

Getting a second opinion and doing a second test aren't the same. We often request second opinions on eg. CT:s or on treatments (and patients will sometimes--but not very often--request a second opinion) but we generally prefer to not make patients undergo extra unnecessary CT:s.

Since I've never once seen a doctor mock a patient or throw one out for questioning his judgement I don't really know what to say to that. The caricature of the greedy American doctor encouraging (wheedling, threatening) patients to undergo unnecessarily expensive diagnostic procedures and treatments comes to mind.

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Ummm all the extra tests are not to rake in more dough...but to prevent getting sued.

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Originally Posted by Veldan Rath

Ummm all the extra tests are not to rake in more dough...but to prevent getting sued.

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It's actually a bit of both. Defensive medicine is one of the major reasons, but there're often financial incentives for eg. referring patients to a friendly radiology clinic for an MRI (eg. a commission, or a direct stake in the radiology clinic).

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Originally Posted by Loki

I've also seen too many make the "easy diagnosis" (i.e. your wrist hurts, it must be because of carpal tunnel; can't sleep, must be because of stress).

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And no, it's not because I pretend to have any medical expertise. From what I've seen, only really good doctors make a proper diagnosis from the first attempt, and other ones need to see you multiple times and do multiple tests before they can do the same.

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Good experienced physicians tend to order fewer and less expensive tests (relying instead on knowledge, experience, a good history and a good clinical exam--unless they're pressured to waste your money), and they can also be better at establishing a good alliance with their patients that lets them get away with such an approach. In the majority of cases you can suss out reasonably likely diagnoses very early based on the history and the clinical exam, with some added help from routine tests. How great you end up looking as a doctor ultimately depends a great deal on how you deal with the uncertainty (and, of course, on lucky you end up being).

If the history and clinical exam strongly suggest carpal tunnel syndrome then carpal tunnel syndrome may in fact be the most likely diagnosis, and it's perhaps also why you're sleeping poorly :mad: I'm kidding, I have no idea why your wrist hurts or why you're not sleeping well.

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Originally Posted by Loki

I've also seen too many make the "easy diagnosis" (i.e. your wrist hurts, it must be because of carpal tunnel; can't sleep, must be because of stress). As someone who understands something called cause and effect, and who spends more than 2 minutes to look at my own file, I actually am in a better position to diagnose myself than most doctors. In fact, I've done a better job of figuring out my problems (and problems of those around me) than most doctors do at first shot. And no, it's not because I pretend to have any medical expertise. From what I've seen, only really good doctors make a proper diagnosis from the first attempt, and other ones need to see you multiple times and do multiple tests before they can do the same.

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Yeah why do we need doctors at all, we should just get more Lokis. :rolleyes:

People make errors, of course. It is pefectly reasonable to make several tests. But this tests will cost already, so how do you (as a patient) want to decide how much is needed. In the end you will be influenced by the first answers you get if you decide to spend more money in simply finding what is the best way to solve your heath problems.

I don't think there is a perfect golden solution to this problem, but I don't think free market will solve it either.

"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country's best electrician on the job (he trained at Harvard, somebody tells you) isn't going to solve this problem. Nor will changing the person who writes him the check.

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here's how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some "skin in the game," and then they'll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care."

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Originally Posted by Aimless

It's actually a bit of both. Defensive medicine is one of the major reasons, but there're often financial incentives for eg. referring patients to a friendly radiology clinic for an MRI (eg. a commission, or a direct stake in the radiology clinic).

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That smacks of being illegal...so go after the doctors that do this instead for fraud/racketeering?

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Originally Posted by Aimless

Good experienced physicians tend to order fewer and less expensive tests (relying instead on knowledge, experience, a good history and a good clinical exam--unless they're pressured to waste your money), and they can also be better at establishing a good alliance with their patients that lets them get away with such an approach. In the majority of cases you can suss out reasonably likely diagnoses very early based on the history and the clinical exam, with some added help from routine tests. How great you end up looking as a doctor ultimately depends a great deal on how you deal with the uncertainty (and, of course, on lucky you end up being).

If the history and clinical exam strongly suggest carpal tunnel syndrome then carpal tunnel syndrome may in fact be the most likely diagnosis, and it's perhaps also why you're sleeping poorly :mad: I'm kidding, I have no idea why your wrist hurts or why you're not sleeping well.

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It's nice and well that the really good doctors don't need extra tests; unfortunately, most doctors aren't that good. So you either get the British/Canadian system, where you're screwed if the first doctor you see isn't great, or the American variant, where you get extra tests, but eventually get the proper diagnosis.

Except most doctors spend a few minutes looking at your medical history and then a few minutes asking for symptoms. They don't even consider any but the most common ailments. They don't spend enough time to ask the kind of questions that would lead to a better diagnosis, and generally aren't smart/experienced enough to know much about rarer diseases. I know several people in England half of whose doctors refused to believe they had depression, for instance, because they happened to be females at an age where constant worrying is apparently normal. One of them ended up not getting treatment for over a year because no one wants to contradict fellow NHS doctors. Someone else wasn't allowed to see a specialist for a month despite one doctor claiming they might go blind if nothing is done (another doctor disagreed and refused to schedule an immediate test).

The sleeping thing actually was in regard to someone I know. The wrist thing turned out to be a genetic bone issue, a possibility the first two doctors I've seen completely ignored (the third was an NYU professor who automatically came up with the diagnosis).

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Originally Posted by Veldan Rath

That smacks of being illegal...so go after the doctors that do this instead for fraud/racketeering?

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Not sure whether it's illegal or not, but virtually every doctor either I or my relatives have seen in the US has done this, including a pretty upscale Manhattan specialist.

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Originally Posted by earthJoker

Yeah why do we need doctors at all, we should just get more Lokis. :rolleyes:

People make errors, of course. It is pefectly reasonable to make several tests. But this tests will cost already, so how do you (as a patient) want to decide how much is needed. In the end you will be influenced by the first answers you get if you decide to spend more money in simply finding what is the best way to solve your heath problems.

I don't think there is a perfect golden solution to this problem, but I don't think free market will solve it either.

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All but the most common ailments have numerous possible symptoms, and those symptoms overlap with many other illnesses. Unless a doctor is very good, there's no way they'll get the proper diagnosis for anything complex after seeing you for 5 minutes. The doctor also doesn't know you well enough to know whether the symptoms you have could have been caused by another issue, nor the chronology of those symptoms (which often matters). It gets even more complicated when you're taking medication for an area in which the doctor is not an expert (and sometimes even an area where they are an expert), and those medication can reasonably be expected to produce some of the symptoms the doctor believes are part of a common illness. With that in mind, would you prefer a system where you're screwed if the first doctor you see doesn't make the proper diagnosis, or a system where you can get extra tests and second opinions?

From what I've seen, the only European who like their healthcare system are those who've never gotten a serious, but non-life threatening ailment (unless it was one the government was prioritizing at the moment). Luckily for those healthcare systems, most people don't get those kind of problems until they're old and their political views are fully formed.